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NCCN Guidelines for Patients


Adolescents and Young Adults with Cancer, Version 1.2017

Infection and low white blood cells

Why it happens

Cancer itself and cancer treatment can put you at risk

for infection by lowering the number of white blood

cells (neutrophils). A severe drop in the neutrophils is

known as neutropenia. These white blood cells help

you fight infection. An infection is caused by germs

like bacteria, viruses, or fungi that enter the body and

grow out of control. Other things like lack of sleep,

stress, and poor diet can also lower your immune

system’s ability to fight an infection.

What you can do

Be aware of what your body is feeling. Frustrating

though it may be, you really need to protect yourself

from germs that your system just isn’t ready to fight.

After all, the last thing you need while battling cancer

is a severe case of the flu. Below are things you can

do to protect yourself.


Buy a good thermometer. Taking your

temperature can help find infections before

they get serious.


When your counts are at their lowest, stay

away from young children or sick people. Tell

people to be extra careful about hand washing

and covering their sneezes and coughs

around you.


Wash your hands. Carry hand sanitizer and

try to use it whenever you touch certain

surfaces like doorknobs. You may want to

avoid shaking people’s hands.


Avoid salad bars and buffets.


Ask friends and family to stay away if they’re

feeling sick, or if they’ve been around a sick



If your white blood cell count is low, ask your

doctor if you should stay home from work

or school. If you can’t stay home, be sure to

wash your hands often.


Get a flu shot every Fall. Talk about when you

should get the shot with your treatment team.

Nerve damage (neuropathy)

Why it happens

Many common chemotherapy drugs can cause

damage to nerve cells that affect normal nerve

signals (neuropathy). Peripheral neuropathy affects

the hands and feet and can begin as sensitivity to

cold, pain, burning, and numbness. It is also said to

cause that feeling of “pins and needles."

Neuropathy can also affect nerves in the ear, leading

to hearing loss, ringing in the ears, and problems

with balance and coordination. Central neuropathy

can cause problems with concentration and memory

that are common in people receiving chemotherapy


Neuropathy usually stops once treatment is over, but

sometimes the neuropathy does not go away. Your

treatment team will want watch for these side effects

very closely.

What you can do

Your treatment team may try to limit your risk by

reducing or skipping one or more doses of a cancer

drug that cause neuropathy

If you have neuropathy, there is medicine and

complementary therapies you can use:


Doctors can prescribe medicine like

gabapentin—a drug to prevent convulsions—

can ease the symptoms of peripheral



Antidepressants such as amitriptyline and

venlafaxine can alter the level of brain

chemicals that control pain signals.


Over-the-counter pain relievers such as

acetaminophen and ibuprofen can relieve the

pain of neuropathy.


Things like acupuncture, massage, and

physical therapy can help as well.


Coping with side effects

How do I cope with side effects?